Risk factors affecting the vital prognosis in patients with rheumatoid arthritis after primary cervical spine surgery: a retrospective study

The effect of biologics on cervical spine lesions (CSLs) and vital prognosis in patients with rheumatoid arthritis (RA) remains unclear. This study investigated the risk factors for a poor vital prognosis in patients with RA requiring primary cervical spine surgery for CSLs. We retrospectively investigated 139 patients with RA who underwent primary cervical spine surgery between January 2001 and December 2020. The vital prognosis was calculated using the Kaplan–Meier method. Patient data were collected from medical records to analyse the risk factors for vital prognosis using univariate and multivariate Cox regression analyses. The vital prognosis was 62.7% at 10 years according to the Kaplan–Meier method. In univariate analysis, advanced age, lower serum albumin levels, high-dose prednisolone administration, non-use of methotrexate, and subaxial subluxation (SAS) comorbidity were significantly associated with a high risk of mortality. In multivariate analysis, advanced age, lower serum albumin levels, high-dose prednisolone administration, and SAS comorbidity were identified as risk factors for a poor vital prognosis. SAS comorbidity, high-dose prednisolone administration, lower serum albumin levels, and advanced age exacerbate the vital prognosis in patients with RA requiring primary cervical spine surgery. Strict disease control aimed at preventing CSL progression to SAS by maintaining the nutritional status and without using steroids is necessary to improve the vital prognosis of patients with RA.